Women in parts of India who are kept in purdah welcome the arrival of the menopause as an era of new freedom; now they can cast off their veils, mix with men and travel freely. In China, the sixtieth birthday is a momentous event, celebrating the status and wisdom of the old person. After the menopause, Bantu women may take part in activities previously forbidden to them, and women in Bali can join in ceremonies from which they were barred during their childbearing years. From India to Africa, from China to South America, the end of menstruation brings new freedom to women. Middle-aged and elderly women are an active part of the extended family, they help on the land, they feel useful, needed and valued. Ageing is a gain in wisdom, not just the loss of youth; in the same way that many cultures celebrate the start of a girl’s menstruation, so its ending is a positive event, too. And in countries where older people have enhanced privilege and status, menopausal symptoms are almost unknown.

How different things are in our ‘advanced’ societies of the West. Ours is a society that gives status and emphasis to physical prowess, to attractiveness and to youth. Men and women (but especially men) lose status when they are no longer defined by the job they do. Children grow up and move away, and the busy mother/chauffeur/cook/nanny/ supporter of the PTA/and helper at Brownies suddenly finds her role has disappeared. In these societies, where getting older is seen as a definite minus, 80 per cent of women suffer from menopausal symptoms.

You probably remember the days when ‘black’ was a term of abuse towards people of African and Caribbean origin. Most black people living in white cultures at that time felt themselves to be inferior to whites, accepting their status as second-class citizens. Then black people themselves coined the phrase ‘Black is Beautiful’, and suddenly their image changed. They felt proud of their black heritage and culture, and of the colour of their skin.

Why shouldn’t older people, too, change how they see themselves, and how society sees them? The Gray Panther movement in the United States is a powerful lobby for the rights of retired people, and they certainly don’t see themselves as has-beens.

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Will I age prematurely if my ovaries are removed?

The answer to this depends on whether you go on hormone therapy, your body size, whether you had your ovaries removed before or after your menopause, and your genetic make-up. Before menopause the ovaries are the body’s main source of hormones such as oestrogen, which has wide-ranging influences on a woman’s body. Some of the areas it affects are:

• the thickness and tone of the vaginal lining and the vagina’s production of secretions

• the fullness, tone and secretions of the vulva, cervix and urethra

• bone structure and growth

• temperament and sexual interest

• the appearance and perhaps function of many other body tissues such as the skin, hair, heart, blood vessels, breasts, liver and joints.

After menopause, most women continue to make measurable and useful amounts of oestrogen in fat and muscle tissue and in the ovaries and adrenal glands (two small organs near the kidneys). How much body fat you have, and your genetic make-up, are among the most important influences on oestrogen levels after menopause.

If you have a slight build and your ovaries are removed before your menopause you are likely to experience more severe, acute menopausal symptoms (such as hot flushes, vaginal dryness, and bladder problems) than if you are well-built and you lose your ovaries after menopause. If you are in the former group, you may also find that your hair seems drier and your skin has less tone and you will also be at increased risk of heart disease and bone thinning (osteoporosis) in later life. For all these reasons you should consider oestrogen replacement therapy (a form of hormone therapy).

Women who are well-built and whose ovaries are removed before menopause tend to experience an intermediate level of symptoms and a slight to moderate increase in their long-term risk of heart disease and osteoporosis. Although such women may find oestrogen supplements useful, they may not be vitally important to their well-being.

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The myth of sleeping pills needs to be destroyed here. Sleeping pills are useful for two weeks only; after that the body develops a tolerance to the pills and they become less and less effective in inducing sleep. The reason why most people continue to take them beyond two weeks is to avoid rebound insomnia. Rebound insomnia is a withdrawal symptom experienced after sleeping pills are stopped. Rebound insomnia should be distinguished from true insomnia. When the sleeping pills are stopped, rebound insomnia follows immediately, and one must be prepared for not sleeping well for the next few nights. Natural sleep should commence after the rebound insomnia passes. Hence it is most important to stop taking the sleeping pills gradually. The tragedy is that most people stop taking the sleeping pills suddenly, and consequently they cannot sleep because they experience rebound insomnia. They then believe they have lost the innate ability to sleep, and they immediately start taking the sleeping pills again.

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